Provider Demographics
NPI:1538205422
Name:QUARTER RAD INC
Entity type:Organization
Organization Name:QUARTER RAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VICARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-234-4642
Mailing Address - Street 1:PO BOX 3553
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-0553
Mailing Address - Country:US
Mailing Address - Phone:812-234-4642
Mailing Address - Fax:812-234-7314
Practice Address - Street 1:2901 OHIO BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-0211
Practice Address - Country:US
Practice Address - Phone:812-234-4642
Practice Address - Fax:812-234-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXF200934261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
1471377OtherFUNDS
IN200533000AMedicaid
630000648OtherPALMETTO
149850OtherMCIL
000000237630OtherBCBS
149850OtherMCIL
=========OtherTAX ID NUMBER